Aims: Only a few studies have investigated the long-term health-related quality of life (HRQoL) in patients with an idiopathic scoliosis. The aim of this study was to investigate the overall HRQoL and employment status of patients with an idiopathic scoliosis 40 years after diagnosis, to compare it with that of the normal population, and to identify possible predictors for a better long-term HRQoL. Methods: We reviewed the full medical records and radiological reports of patients referred to our hospital with a scoliosis of childhood between April 1972 and April 1982. Of 129 eligible patients with a juvenile or adolescent idiopathic scoliosis, 91 took part in the study (71%). They were evaluated with full-spine radiographs and HRQoL questionnaires and compared with normative data. We compared the HRQoL between observation (n = 27), bracing (n = 46), and surgical treatment (n = 18), and between thoracic and thoracolumbar/lumbar (TL/L) curves. Results: The mean time to follow-up was 40.8 years (SD 2.6) and the mean age of patients was 54.0 years (SD 2.7). Of the 91 patients, 86 were female (95%) and 51 had a main thoracic curve (53%). We found a significantly lower HRQoL measured on all the Scoliosis Research Society 22r instrument (SRS-22r) subdomains (p < 0.001) with the exception of mental health, than in an age-matched normal population. Incapacity to work was more prevalent in scoliosis patients (21%) than in the normal population (11%). The median SRS-22r subscore was 4.0 (interquartile range (IQR) 3.3 to 4.4) for TL/L curves and 4.1 (IQR 3.8 to 4.4) for thoracic curves (p = 0.300). We found a significantly lower self-image score for braced (median 3.6 (IQR 3.0 to 4.0)) and surgically treated patients (median 3.6 (IQR 3.2 to 4.3)) than for those treated by observation (median 4.0 (IQR 4.1 to 4.8); p = 0.010), but no statistically significant differences were found for the remaining subdomains. Conclusion: In this long-term follow-up study, we found a significantly decreased HRQoL and capacity to work in patients with an idiopathic scoliosis 40 years after diagnosis. Cite this article: Bone Joint J 2023;105-B(2):166–171.

BACKGROUND CONTEXT: Pulmonary function in patients with scoliosis has been a topic of concern, with some reports of markedly decreased ventilatory function leading to disability and increased mortality in patients with severe scoliosis. Only limited data is available concerning pulmonary function in adult patients with scoliosis. PURPOSE: To report the long-term pulmonary function (PF) in patients diagnosed with idiopathic scoliosis (IS) compared with an age-matched population using extended pulmonary function testing (EPFT). STUDY DESIGN/SETTING: Retrospective clinical follow-up. PATIENT SAMPLE: A total of 177 patients seen at our institution from 1972 to 1983 for a pediatric spinal deformity were assessed for inclusion in the study. About 77/129 eligible patients with IS (60%) partook in a clinical examination including radiographs, and EPFT. OUTCOME MEASURES: The EPFT values included forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, vital capacity (VC), total lung capacity (TLC), residual volume (RV), RV/TLC ratio, diffusion capacity of carbon monoxide (DLco), carbon monoxide transfer coefficient (KCO) and alveolar volume (VA). Results were expressed with z-scores derived from height and arm span normative data. Z-scores were calculated as z-score=Measured PF-Predicted PF /Relative standard deviation (RSD). The limits of normal, are defined as the 5th and 95th percentile limits (z-score between- 1.645 and 1.645), respectively. METHODS: Patients underwent a clinical examination with full spine standing radiographs and EFPT. The results were compared between patients with thoracic and thoracolumbar/lumbar (TL/ L) main curves, and overall compared with a background population. Results were expressed with z-scores derived from height and arm span normative data. RESULTS: Of 77 included patients, 76 (99%) were females with a mean age of 54.6 +/- 2.5 years. The mean follow-up time was 40.8 +/- 2.8 years. Forty-four patients had thoracic main curves, and 33 had TL/L main curves. We found no pulmonary impairment based on z-scores in the total cohort or between groups, with only patients who were current or previous smokers, having z-scores below the normal limits Patients with main thoracic curves displayed significantly lower PF on mean absolute values and mean z-scores on FEV1, FVC, FEV1/FVC ratio, VC, TLC, and DLco compared with main TL/L curves. Patients with thoracic curves had significantly larger Cobb angles at follow-up; 52 +/- 17 & ring; compared with 40 +/- 22 & ring; (p-value < .05) in the TL/L group. We found no linear association between thoracic Cobb angle and degree of pulmonary impairment assessed with DLco, TLC, and FVC. Comparison of pulmonary z-scores based on arm span data, differed significantly on FVC and TLC, with the arm span measurements showing lower mean z-scores (p-value < .05).

There is limited knowledge on diffusing capacity in scoliosis patients. It remains to be determined if impaired pulmonary diffusing capacity is mostly influenced by reduced alveolar–capillary membrane diffusing capacity (D_{M, CO}), reduced pulmonary capillary blood volume (V_C) or both. This study aims to report findings from dual test gas pulmonary diffusing capacity for carbon monoxide and nitric oxide (D_{L, CO, NO}) with quantification of pulmonary diffusing capacity for carbon monoxide corrected for haemoglobin with a five s breath‐hold (D_{L, COc, 5s}) and nitric oxide with a five s breath‐hold (D_{L, NO, 5s}), D_{M, CO} and V_C. The study included 57 patients with idiopathic scoliosis seen at our department from 1972 to 1983, all of whom underwent radiological assessment and measurement of D_{L, CO, NO} during examination 40 years after diagnosis. One‐way ANOVA was performed for between‐group differences and Pearson's correlation coefficient was used to assess correlations between D_{L, CO, NO} metrics and Cobb angle. No significant between‐group differences based on disease severity were detected. Thirty‐nine percent of the patients were presented with either reduced D_{L, COc, 5s} or reduced D_{L, NO, 5s} represented as Z‐scores below −1.65. No significant correlations between Cobb angle and Z‐scores for D_{L, COc, 5s}, D_{L, NO, 5s}, D_{M, CO} and V_C according to height measurements were found. When using arm span instead, a weak negative correlation between D_{L, COc, 5s} and Cobb angle (r = −0.29; P = 0.04) was detected. In conclusion, approximately 39% of patients with idiopathic scoliosis had either reduced D_{L, COc, 5s} or reduced D_{L, NO, 5s} 40 years after diagnosis with varying contributions from V_C or D_{M, CO}.

Purpose: To examine if coronal deformity angular ratio (C-DAR) serves as a predictor for progression to surgical magnitude in patients with Adolescent Idiopathic Scoliosis (AIS) treated with thoracolumbar sacral orthosis (TLSO). Methods: Patients with AIS, prescribed a full-time TLSO, Cobb angle 20–40°, Risser 0–2, who wore the brace ≥ 12.9 h and reached skeletal maturity/surgery were included retrospectively. C-DAR was defined as the Cobb angle divided by the number of vertebrae in the curve, yielding a larger value in short curves. The association between C-DAR and the risk of progression to surgical magnitude (> 45°) was assessed. Secondly, we evaluated the association between pre-treatment Cobb angle and in-brace correction on the risk of progression to > 45°. Results: We included 165 patients with a mean Cobb angle of 30 ± 6°. Of these, 46/165 (28%) progressed ≥ 6° and 26/165 (16%) reached surgical magnitude at the end of treatment. C-DAR was a significant predictor for risk of progression to surgical magnitude with an OR of 1.9 (CI 1.2–2.9) per unit increase in C-DAR. A threshold value of 5.15 was established and demonstrated an OR 5.9 (CI 2.1–17.9) for curve progression to a surgical magnitude. Likewise, pre-treatment Cobb angle showed a significant OR 1.3(CI 1.2–1.4) per degree increase in Cobb, whereas in-brace % correction showed OR 0.96 (CI 0.93–0.98). Conclusion: C-DAR is an independent predictor for progression to a surgical magnitude in AIS patients treated with bracing. Patients with a higher C-DAR should be counseled to help set realistic expectations regarding the likelihood of curve progression despite compliance with brace wear.

Study design: This is a retrospective single-center study. Purpose: The purpose is to investigate the incidence of distal junctional kyphosis (DJK) when fused proximal to the stable sagittal vertebra (SSV) in adolescent idiopathic scoliosis (AIS) patients undergoing selective thoracic fusion. Methods: We retrospectively reviewed a consecutive cohort of surgically treated AIS patients with Lenke 1–2 A/B curves between 2011 and 2022 with a minimum of 2 years of follow-up. The SSV was defined as the vertebra bisected by the posterior sacral vertical line on long-standing sagittal radiographs. All patients underwent posterior pedicle screw instrumentation, and the decision of fusion level was at the surgeons’ discretion. Distal junctional kyphosis was defined as ≥10° angulation between the lower instrumented vertebra (LIV) and the vertebra below the LIV (LIV + 1). Patients were stratified into Fusion proximal of SSV (Prox-SSV) and fusion including SSV (Incl-SSV). Multivariable backward regression was performed to identify predictors for DJK. Results: A total of 196 patients were included, with 80 in the Prox-SSV group. The overall DJK rate was 3.6% (7/196), occurring in 6.3% (5/80) in the Prox-SSV group and 1.7% (2/116) in the Incl-SSV group, respectively ( p = 0.125). Fusion proximal of SSV did not significantly increase DJK risk (Univariate OR 7.98, 95% CI 0.87–66.6; excluded in multivariable regression). Using SSV for LIV selection would extend the fusion by one level in 63.8%, two in 25.0%, and three in 11.2% of patients. Conclusion: The overall risk of DJK is small in thoracic curves and fusion proximal to the SSV did not significantly increase the risk of DJK. Standardized use of SSV as LIV would result in a substantial extension of the fusion area with questionable benefits to the patients.